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From WHI 2001 to NAMS 2012 an evolution

Since the Women’s Health Initiative 2001 findings, there has been a decade of progress regarding menopause treatment research. Yet despite the latest findings, some women and healthcare providers may still adhere to the link between hormone therapy (HT) and increased risk of health issues including breast cancer. Can we move forward and understand that no single study is the final authoritative voice, but a part of the bigger overall picture?

Dr. Margery Gass, Executive Director for the North American Menopause Society gives a solid perspective on how science is an evolution and what this means for menopausal women. ‘The data are still largely coming from that study giving us a fine tuning if you will and a more thorough understanding of this important research. When that study was designed, nobody expected there would be different risk benefits ratios by age.

Normally we do not have other medications like that tend to be riskier at one age than another. Take for example medications for high blood pressure. The risks for developing high blood pressure itself do tend to increase with age, but when it comes to analyzing the medications, we usually do not expect to see widely varied risk-benefit ratio mixes for different ages. In fact, most medications do not give a lot of attention to that issue.

Originally, hormone therapy was all supposed to be analyzed together as one big project. Now a decade later, age is the main factor happening here with hormones. We are focusing on the risks and benefits of 50-59 year old women; those women taking prescriptions earlier on in menopause and for shorter time periods compared to the past. This also helps to separate this age group from a study that may concentrate on women over 65 who may be taking hormones for osteoporosis, and subsequently have a different set of health benefits and risks.

We know that women who have earlier menopauses or menopauses at a younger age than 51 will have decreased risks and incidences of breast cancer than those women who have later menopauses. . And so in a way taking your hormones is just like having your menopause a year or two later or for however long you take them.’

I asked Dr. Gass to clarify whether the same dosage amounts for HT were examined in the 2001 WHI compared to now and whether that may explain part of the change in findings.

Dr. Gass: ‘The same doses prescribed today were used in the WHI study in accordance with The Health Effectiveness Data and Information Set (HEDIS) guidelines When we look at back around the time of 2000, menopause management differed slightly from today’s approach.

At that time, the tendency was that HT would probably prevent osteoporosis, and heart disease; it might prevent dementia. HT was seen as a fountain of youth that would deal with the chronic problems of aging beyond just the immediate menopausal symptoms. The general guidelines in the US at that time were recommending putting women on it (HT) forever.

It is very important to note that even back then when many people were recommending that all women take HT forever, 2/3 women stopped taking their prescriptions before a year was up. This does not argue for a strong quality of life benefit, because if people were truly feeling so much better on hormones they would still take them; why would they quit? So if women decided of their own free will to stop taking hormones even when advised to take them, this is a very strong statement about the number of women who truly needed HT.

So things have to be put in perspective because are there other prescriptions and practical measures that are available. For example, there are a lot of practical measures that women can put into practise that can reduce the number of hot flashes with the natural course of hot flashes is that they become milder and less frequent and eventually dwindle out.

Now let’s examine a more complex situation. for the woman who is moody for example let’s say her symptoms may be some hot flashes and some moodiness and irritability, there are Selective Serotonin Reuptake Inhibitors (SSRI) drugs that have been found to be helpful to deal with forms of depression. So that might be an option for someone who does not want to use hormones but might like something stronger than simply finding ways to control the temperature or the exposure to triggers for hot flashes.’

This series continues with an exploration into what women need to know to put the risks and benefits of HT into perspective when deciding on menopause treatments.